Does musculoskeletal health literacy differ between urban and rural orthopaedic patients?

Abstract

Background: Many patients lack the necessary skills needed to make informed decisions regarding their health. This critical skill set, broadly defined as health literacy, is influenced by various demographic factors including age, gender, ethnicity, education, and socioeconomic status. Patients seeking care for musculoskeletal ailments are afflicted by low health literacy, with several studies identifying higher rates of inadequate musculoskeletal health literacy than general health literacy. This study aimed to evaluate and compare the prevalence of limited musculoskeletal health literacy in patients seeking orthopaedic care in both urban and rural environments, looking at the geographical distribution in a single state. Methods: Validated health literacy assessment instruments and demographic surveys were administered to patients seeking musculoskeletal care in two emergency departments (one rural, one urban). Patients were eligible to participate if they had a single musculoskeletal complaint, were at least 18 yr old, and spoke English. Results: There were 55 participants in the rural emergency department (ED), and 65 in the urban ED. Adequate general health literacy was found in 62% of rural and 52% of urban patients, while 44% of rural and 43% of urban patients had adequate musculoskeletal health literacy. There was no significant difference in the prevalence of adequate health literacy between the two populations, but both cohorts had significantly worse rates of musculoskeletal health literacy as compared to general health literacy (P<0.05). Conclusions: This study confirms that there is a greater prevalence of limited musculoskeletal health literacy as compared to general health literacy, and that this transcends geographic boundaries.